Abstracts: Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; November 9-12, 2014; San Antonio, TX

Abstract

Factors affecting risk and outcome of ovarian cancer are understudied among African American women despite notable differences in the incidence, age at diagnosis, and survival rates compared to European American women. African American women have a lower risk of developing ovarian cancer than European American women, but so far, the relationship between socioeconomic status and ovarian cancer risk has yet to be clearly established.

To address this gap in the evidence, the purpose of this study was to investigate the potential association between socioeconomic status and ovarian cancer in African American women. This population-based case-control study consisted of incident ovarian cancer cases (n=325) and matched controls (n=547). The participants were recruited during the first three years (from April, 2011 through June, 2014) of the African American Cancer Epidemiology Study (AACES). AACES is an ongoing multi-site study to investigate factors associated with ovarian cancer in African American women in the following ten states: Alabama, Georgia, Louisiana, Michigan, New Jersey, North Carolina, Ohio, South Carolina, Tennessee, and Texas. During interviewer administered questionnaires, study participants responded to questions that included the measures of socioeconomic status used in this report, years of education and family annual income, along with items related to a wide range of lifestyle behaviors and ovarian cancer risk factors.

After adjusting for age, body mass index, parity, family history of ovarian or breast cancer, tubal ligation, and history of oral contraceptive use, compared to those with a high school education or less, the odds ratios (and 95% confidence intervals (CIs)) were 0.69 (0.50-0.97) for those with some education after high school but less than a college degree and 0.74 (0.50-1.09) for those with a college degree and beyond. Adjusting for the same factors, compared to those with a family annual income of <$10,000, the ORs (and 95% CIs) were 1.18 (0.77-1.81), 1.26 (0.82-1.95), and 0.85 (0.55-1.29) for those with family annual incomes of $10,000 to <$25,000, $25,000 to <$50,000, and ≥$50,000, respectively. For both education and income, the unadjusted results were almost identical to the adjusted results presented above.

The associations of education and income with ovarian cancer risk did not reveal clear dose-response trends and many of the associations were not statistically significant. Nevertheless, based on the observations that 1) higher levels of education were inversely associated with ovarian cancer risk and 2) individuals with the highest income level had a non-significantly lower risk than those with the lowest income level, these findings offer enticing clues that ovarian cancer risk may be inversely associated with socioeconomic status among African American women. As a next step, we will be integrating potential mediating and effect modifying variables such as marital status and health insurance into these analyses to more precisely characterize the observed inverse association between socioeconomic status and ovarian cancer risk.